The misuse and potential inappropriate prescribing of prescription opioid analgesics is a growing public health concern in the U.S. The dramatic increase in prescription opioid use has led to disconcerting effects including misuse, abuse, and negative health consequences such as death from overdose and increased utilization of healthcare services. Even with heightened awareness of this issue, the majority of states have not developed strategies to help curb prescription drug abuse. Inappropriate prescribing of opioids is a key factor related to the misuse of these medications and related negative health outcomes. Prescribing high doses of opioids, concomitant opioid-opioid/opioid-benzodiazepine/opioid- Suboxone use, prescribing opioids for long durations, and prescribing long acting/extended release opioids for acute pain or for opioid naive patients are indicators of inappropriate prescribing. By creating formulary policies to limit access to opioid analgesic prescriptions under these conditions, policy makers and formulary managers have the potential to reduce the misuse and inappropriate prescribing of opioids, unnecessary healthcare utilization and overdose deaths. The proposed study uses Georgia and North Carolina Medicaid pharmacy and medical claims data from 2009 to 2014 to evaluate the impact of Georgia Medicaid formulary policy changes on three outcomes: 1) potential misuse and inappropriate prescribing of opioid analgesic medications; 2) utilization of healthcare services; and 3) deaths due to overdose. This study will directly measure the impact of formulary policy changes implemented by Georgia Medicaid in 2012/2013 designed to limit abuse, misuse, diversion and inappropriate prescribing, health services utilization and deaths from overdose. These policies include a limit on the number of prescriptions allowed per recipient per month, a change in the refill-too-soon rate from 75% of days' supply used to 85% of days supply used, and blocking concomitant use of any opioid and Suboxone. Study hypotheses are tested using descriptive statistics and panel data econometric analyses techniques. This innovative research is among the first studies to examine the impact of formulary policy changes on these three important contributors to the opioid crisis. Results of the study will provide evidence regarding the effectiveness of policy-level strategies to reduce misuse and inappropriate prescribing of opioids which is expected to lead to improved patient outcomes, decreased utilization of healthcare services and reduced costs of medical care. Results will inform key decision makers, allowing them to choose approaches that are most likely to reduce misuse of prescription drugs and drug overdose in states as well as to help states identify strategies that are effective in addressing a national crisis related to the abuse of prescription opioid analgesics.